Moderate-to-large increases in perioperative serum sodium concentration associated with adverse neurologic events after continuous flow left ventricular assist device implantation

Document Type

Journal Article

Publication Date

4-1-2015

Journal

Journal of Cardiothoracic and Vascular Anesthesia

Volume

29

Issue

2

DOI

10.1053/j.jvca.2014.07.029

Keywords

hyponatremia; mortality; seizure; stroke; ventricular assist device

Abstract

Objective It was hypothesized that preoperative hyponatremia is associated with increased 30-day mortality after left ventricular assist device placement, and that large increases in sodium concentration are associated with adverse neurologic events and 30-day mortality. Design Data were collected retrospectively on all patients having continuous flow left ventricular assist device implantation between January 1, 2009 and March 31, 2013. Preoperative variables, operative variables, and perioperative sodium concentrations were recorded. Both 30-day mortality and 72-hour adverse neurologic events (stroke or seizure) were recorded as primary outcome variables. Preoperative sodium and Δ sodium (postoperative sodium-preoperative sodium) were analyzed as tests for 30-day mortality and adverse neurologic events using receiver operating characteristic curves. Both crude and adjusted logistic regression analyses were used to estimate odds ratios for the outcome variables. Setting Tertiary care academic medical center. Participants Patients having durable continuous flow left ventricular assist device placement. Interventions None. Measurements and Main Results Among 88 patients, 30-day mortality was 14% (12 of 88) and the rate of perioperative stroke or seizure was 9% (8 of 88). There were 3 strokes and 5 tonic-clonic seizures. Preoperative sodium was a poor discriminative test for 30-day mortality and stroke or seizure (AUC = 0.47 and 0.57, respectively). Δ sodium was a poor discriminative test for 30-day mortality, but a fair discriminative test for stroke or seizure (AUC = 0.55 and 0.78, respectively). Δ sodium was a good discriminative test for seizure alone (AUC = 0.82) and a fair discriminative test for stroke alone (AUC = 0.70). It also increased the odds of stroke or seizure significantly, even when adjusting for possible confounders. Conclusions Moderate-to-large increases in sodium concentration during left ventricular assist device placement appear to be associated with adverse postoperative neurologic events. Preoperative hyponatremia has no relationship with 30-day mortality or adverse perioperative neurologic events.

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